Step 1
Patient Receives Oxaliplatin Infusion
Monitor closely, especially in first 15–30 minutes.
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Step 2
Reaction Observed?
If NO → Continue infusion with monitoring.
If YES → Proceed below.
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Step 3
STOP Infusion Immediately
Maintain IV access. Assess airway, breathing, circulation (ABCs).
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Step 4
Assess Severity:
- Mild (Grade 1–2): flushing, rash, pruritus, mild dyspnea
- Severe (Grade 3–4): bronchospasm, hypotension, anaphylaxis
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Step 5
Immediate Management
- Oxygen & vital signs monitoring
- H1 antihistamine (diphenhydramine 25–50 mg IV)
- H2 antagonist (famotidine 20 mg IV)
- Corticosteroid (dexamethasone 8–20 mg IV)
- For bronchospasm: inhaled β2-agonist (albuterol)
- For anaphylaxis: epinephrine IM (0.3–0.5 mg, 1:1000)
- IV fluids for hypotension
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Step 6
Post-Reaction Decision:
- Mild/Moderate: Consider rechallenge with slower rate + premedication.
- Severe/Anaphylaxis: Permanently discontinue oxaliplatin; switch regimen.